MEDICARE: SUMMIT REHABILITATION AND WELLNESS CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1790766061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT REHABILITATION AND WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	294 NE TUDOR RD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-5696
Country	:	US
Telephone Number	:	816-554-6003
Fax Number	:	816-554-6013

Provider Business Practice Location Address
First Line	:	294 NE TUDOR RD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-5696
Country	:	US
Telephone Number	:	816-554-6003
Fax Number	:	816-554-6013

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JANE BURNETT
Credential	:	PT
Telephone Number	:	816-554-6003

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	01/11/2012

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